Changes in voiding function after transvaginal mesh repair for advanced anterior vaginal prolapse

Objective: This study evaluated changes in voiding function at 3 months and 1 year after transvaginal mesh (TVM) repair in women with advanced anterior vaginal prolapse (AVP) and identified predictive risk factors of postoperative voiding dysfunction (PVD).

Study design: Women with stage≥3 AVP who underwent TVM repair surgery were included in this retrospective cohort study. Voiding dysfunction was defined as an average flow rate (Q_ave)＜10 ml/s, a maximum flow rate (Q_max)＜15 ml/s, or a postvoid residual volume (PVR)＞50 ml. Pre- and postoperative voiding function was assessed by uroflowmetry, PVR examination, and the Urinary Distress Inventory-6 (UDI-6) and the Urinary Impact Questionnaire-7 (UIQ-7). Statistical analyses were performed using paired-sample t tests, χ2 tests, and multivariate logistic regression.

Results: Sixty-two women were included in this study, uroflowmetry data were available for 35 of them at 1-year follow-up. Forty-three percent of women showed evidence of voiding dysfunction preoperatively. The PVR decreased significantly from baseline to 1 year postoperatively (17.97 ± 38.48 vs. 0.00 ± 0.00, p < 0.001). Voiding difficulties decreased significantly postoperatively (55 % vs. 5%, p＜0.001); frequency, urgency and urinary incontinence symptoms did not exhibit significant improvement (p＞0.05). The UDI-6 and UIQ-7 indicated significant improvement postoperatively (both p＜0.001). Multivariate analysis identified low Q_ave as an independent predictor of PVD (odds ratio, 0.40; 95 % CI, 0.16-0.98).

Conclusion: Nearly half of the patients had advanced AVP accompanied by preoperative voiding dysfunction. Improvement in voiding function was observed at 3 months and could last for one year postoperatively.